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7. CP - Kidney and Urinary Tract Disease > (33) Urogenital Pathology > Flashcards

(33) Urogenital Pathology Flashcards

1
Q

What is nodular prostatic hyperplasia also know as?

A

Benign prostatic hyperplasia (BPH)

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2
Q

What is nodular prostatic hyperplasia/BPH?

A

Enlargement of the prostate - overgrowth of the epithelium and fibromuscular tissue of the transition zone and periurethral area

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3
Q

What are the lower urinary tract symptoms (LUTS) of BPH?

A
  • urgency
  • difficulty starting urination
  • diminished stream size and force
  • increased frequency
  • incomplete bladder emptying
  • nocturia
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4
Q

What causes the LUTS in BPH?

A

Interference with the muscular sphincteric function and by obstruction of urine flow through the prostatic urethra

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5
Q

The normal prostate contains several distinct regions. Name 4 regions

A
  • central zone
  • peripheral zone
  • transitional zone
  • periurethral zone
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6
Q

Where do most carcinomas of the prostate arise from?

A

The peripheral glands of the organ - may be palpable on digital examination of rectum

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7
Q

In contrast to carcinomas, where does nodular prostatic hyperplasia arise?

A

More centrally situated glands - more likely to produce urinary obstruction earlier than carcinoma

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8
Q

Development of nodular hyperplasia includes what 3 pathologic changes?

A
  • nodule formation
  • diffuse enlargement of the transition zone and periurethral tissue
  • enlargement of nodules
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9
Q

Which feature of nodular hyperplasia is predominant among under 70s

A

Diffuse enlargement of transition zone and periurethral tissue

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10
Q

Which feature of nodular hyperplasia is predominant among older men?

A

Nodule formation and enlargement of nodules

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11
Q

Describe 2 histologically different types of nodules you can get in nodular hyperplasia

A
  • pure stromal nodule (uniform and circumscribed with stromal fibroblasts and scattered lymphocytes)
  • mixed epithelial-stromal nodule
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12
Q

What is the aetiology behind BPH?

A
  • impaired cell death = accumulation of senescent cells in prostate
  • androgens (mainly DHT) involved in BPH can increase cellular proliferation and inhibit cell death
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13
Q

95% of prostatic malignancies are what type?

A

Prostatic adenocarcinoma

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14
Q

At what age does the incidence of prostatic adenocarcinoma rise quickly?

A

40 years

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15
Q

What is the different between autopsy-based prevalence and clinical incidence of prostatic adenocarcinoma?

A

Autopsy studies of prostates from men without clinical evidence of cancer have sown a very high level of latent cancer

autopsy > clinical

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16
Q

The incidence of prostatic adenocarcinoma is much higher in men of what ancestry?

A

African (100 per 100,000)

compared to European (70.1 per 100,000)

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17
Q

How is cancer of the prostate treated?

A
  • surgery
  • radiation
  • hormonal manipulations
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18
Q

How long can those receiving treatment for prostate cancer expect to live?

A

More than 90% of patients who receive such therapy can expect to live for 15 years

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19
Q

What is the most common treatment for clinically localised prostate cancer?

A

Radical prostatectomy

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20
Q

What is the prognosis following radical prostatectomy based on?

A
  • pathologic stage
  • margin status
  • Gleason grade
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21
Q

What are the alternative treatments for localised prostate cancer? (other than radical prostatectomy)

A
  • external-beam radiation therapy

- interstitial radiation therapy (brachytherapy)

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22
Q

External-beam radiation therapy is also used to treat prostate cancer that is what?

A

Too locally advanced to be cured by surgery

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23
Q

What are the risk factors involved in carcinoma of the prostate?

A
  • age
  • race
  • family history
  • hormone levels (androgens)
  • environmental influence eg. increased consumption of fats
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24
Q

Which hormones play a big part in prostate cancer?

A

Androgens

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25
What role do androgens play in prostate cancer?
Maintain growth and survival of prostate cancer cells
26
How can the effects of androgens in prostate cancer be seen?
In the therapeutic effect of castration or treatment with anti-androgens, which usually induce disease regression
27
How does family history (inherited polymorphisms) affect risk of prostate cancer?
- 1 first-degree relative with prostate cancer = 2x the risk - 2 first-degree relatives = 5x the risk Strong family history also = develop disease at earlier age
28
Men with germline mutations of which gene have a 20-fold increase in risk of prostate cancer?
tumour suppressor BRCA2 gener
29
What is currently the only accepted grading system for prostate carcinoma?
Gleason scoring system (recommended by WHO)
30
What are the 5 stages of prostate cancer according to Gleason scoring system?
1. Small, uniform glands. Well differentiated 2. More stroma between glands 3. Distinctly infiltrative margins. Moderately differentiated 4. Irregular masses of neoplastic cells 5. Only occasional gland formation. Poorly differentiated/anaplastic
31
Why might screening for prostate cancer not be beneficial?
- role of PSA - false positives and false negatives - complications of treatment (impotence, incontinence etc) - unnecessary treatments - limited benefits - consideration in high risk groups - reduced mortality vs. risks of over treatment
32
Who is the incidence of testicular tumours highest amongst globally?
Among men of northern European ancestry Lowest among men of Asian and African descent
33
What pre-existing medical conditions have been associated with development of testicular germ cell tumours (TGCT)?
- prior TGCT in the contralateral testicle - cryptorchidism - impaired spermatogenesis - inguinal hernia - hydrocele - disorders of sex development - prior testicular biopsy - atopy - testicular atrophy
34
What is cryptorchidism?
The absence of one or both testes from the scrotum. It is the most common birth defect of the male genitalia
35
Name 2 types of testicular cancer
- seminoma | - teratoma
36
At what age is seminoma most common?
35-45 yrs - uncommon in men >50 - rare in children
37
At what age is teratoma most common?
In the 1st and 2nd decades of life
38
Describe the typical clinical presentation of seminoma
- testicular enlargement - with or without pain - metastases - some patients have no symptoms - rare symtoms = gynaecomastia, exophthalmos, infertility
39
What is the typical clinical presentation of teratoma?
- gradual testicular swelling | - with or without pain
40
Can mature teratoma be benign?
Mature teratoma is almost always benign in prepubertal patients However, it can pursue an aggressive clinical course after puberty i.e. metastasis
41
Immature teratoma is a common component of what?
NSGCTs (non-seminomatous germ cell tumours) Teratoma in its pure form is very rare
42
What are the tumour markers in seminoma?
- elevated serum PLAP (40%) | - elevated hCG (10%) - cause of gynaecomastia
43
What are the tumour markers in teratoma?
Purely teratomatous tissues do not secrete tumour markers
44
Describe the macroscopic appearance of seminoma
- well-demarcated - cream-coloured - homogeneous - coarsely lobulated
45
Describe the microscopic appearance of teratoma
- monotonous polygonal cells with mostly clear cytoplasm and central nuclei divided into lobules by thin bands of fibrovascular stroma
46
Describe the microscopic appearance of teratoma
- mixture of ectoderm, endoderm, and mesoderm
47
Name 7 inflammatory conditions of the testis
- acute and chronic epididymoorchitis - idiopathic granulomatous orchitis - sarcoidosis of the testis - malakoplakia of testis - myofibroblastic pseudo tumour of testis - sperm granuloma - tuberculous orchitis
48
What do you seen on histology in acute/chronic epididymoorchitis?
- ghostly outlines of infarcted seminiferous tubules | - surrounded by purulent exudate containing neutrophils and other inflammatory cells
49
Idiopathic granulomatous orchitis typically presents in older adults, with associated symptoms of what?
- UTI - trauma - flu-like illness
50
What happens to the testis in idiopathic granulomatous orchitis?
Becomes swollen, painful and tender initially but later may have a residual mass indistinguishable from a neoplasm, prompting orchiectomy
51
What causes the granulomatous appearance in idiopathic granulomatous orchitis?
No granulomas present but the interstitial and intratubular aggregation of epithelioid histiocytes, lymphocytes and plasma cells imparts a granulomatous appearance
52
Sarcoidosis can affect the testis. What may it mimic?
Malignancy, particularly if accompanied by radiologic pulmonary abnormalities
53
What may you see on histology in sarcoidosis of the testis?
- non-nectrotising granulomas involving testicular parenchyma - special stains for fungal organisms and acid-fast bacilli are negative
54
What may malakoplakia affect?
Only the testis, or less commonly, both the testis and the epididymis
55
What does malakoplakia of the testis result in the formation of?
Soft yellow, tan, or brown nodules that replace normal testicular parenchyma
56
What is seen on histology in malakoplakia of the testis?
The tubules and interstitium are extensively infiltrated by large histiocytes that have abundant eosinophilic granular cytoplasm
57
What are the histiocytes called in malakoplakia?
von Hansemann histiocytes
58
What is myofibroblastic pseudotumour of testis?
An atypical inflammatory and myofibroblastic reaction with fasciitis-like large cells Features of malignancy are absent A benign reactive and proliferative process of uncertain aetiology
59
What is a sperm granuloma?
An exuberant foreign body giant cell reaction to extravasated sperm
60
How common is sperm granuloma?
Occurs in up to 42% of patients after vasectomy 2.5% of routine autopsies
61
What are signs and symptoms of sperm granuloma?
May have no symptoms Often present with history of pain and swelling of the upper pole of the epididymis, spermatic cord, and rarely, the testis Others have a history of trauma, epididymiditis and orchitis
62
Where is the reservoir for tuberculous involvement in the male genital tract?
The epididymis With secondary testicular involvement and other local sites of involvement in about 80% of cases
63
How many cases of renal tuberculosis are accompanied by epididymis infection?
40%
64
How do patients usually present with tuberculous orchitis?
With painless scrotal swelling Other signs include unilateral or bilateral mass, infertility, and scrotal fistula
65
What kind of inflammation do you get in tuberculous orchitis?
Caseating granulomatous inflammation is prominent, with fibrous thickening and enlargement of the epididymis and adjacent structures
66
What makes up 25% of cases of empty scrotum?
Cryptorchidism
67
In, cryptorchidism, where are the testes most frequently found?
In the inguinal canal or upper scrotum; arrest within the abdomen is less frequent
68
On which side is cryptorchidism more common?
Slightly more common on the right; 18% are bilateral
69
What is the causes of congenital cryptorchidism?
Anomalies in anatomic development or hormonal mechanisms involved in testicular descent
70
What are the causes of acquired cryptorchidism?
Postoperative or spontaneous ascent - inability of spermatic vessels to grow adequately - anomalous insertion of the gubernaculum - failure in reabsorption of the vaginal process - failure in postnatal elongation of the spermatic cord
71
What are the potential complications associated with cryptorchidism?
- testicular atrophy - infertility - carcinoma (TGCTs)
72
What is hypogonadism?
Reduction or absence of hormone secretion or other physiological activity of the gonads (testes or ovaries).
73
What are the primary causes of hypogonadism/testicular failure?
- undescended testis - Klinefelter syndrome - haemochromatosis - mumps - orchitis - trauma - CF - testicular torsion - variocele
74
What are the secondary cause of hypogonadism/testicular failure?
- pituitary failure - drugs (glucocorticoids, ketoconazole, chemotherapy, opioids) - obesity - aging
75
What is Klinefelter syndrome?
Set of symptoms that arise from 2 or more X chromosomes in males 47 XXY
76
What is variocele?
An abnormal enlargement of the pampiniform venous plexus in the scrotum

7. CP - Kidney and Urinary Tract Disease (5 decks)

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